Medicare enrollment window closes Saturday

The state's seniors are reaping the benefits from the Affordable Care Act's gradual closing of the Medicare "donut hole" for prescription drug coverage.

In Virginia, almost 74,000 residents, age 65 and older, saved more than $61.6 million in 2013 as policies to close the gap gradually phased in, according to a Centers for Medicare and Medicaid Services (CMS) report released last week. The average discount per beneficiary in Virginia amounted to $837 per recipient.

The "donut hole" refers to the gap in prescription coverage that Medicare participants reach when their plan has paid more than $2,970 for drugs and before catastrophic coverage kicks in after they've paid approximately $4,450 out-of-pocket in a year. (The numbers change slightly each year.)

The annual open enrollment period for Medicare health and drug plans began Oct. 15 and ends Saturday.

There are two ways to get drug coverage through Medicare: with Part D, or a Medicare Advantage Plan, known as Part C. People who don't have other creditable prescription drug coverage who delay in enrolling in Medicare prescription coverage when first eligible are liable for a penalty when they do enroll. Seniors are encouraged to review their drug plans and formularies annually in order to maximize their benefits.

The CMS web site assures "If a person is satisfied that their current plan will meet their needs for next year, they don't need to do anything." It also emphasizes that the ACA's state insurance marketplaces, which opened on Oct. 1 and run through March 2014, have no bearing on those receiving Medicare. "The Marketplace won't have any effect on your Medicare coverage," it emphasizes. Lisa Walker, vice president Aging and Disability Resources for Bay Aging, has received a lot of questions from seniors about how the Affordable Care Act affects them. "For folks on Medicare, they have insurance and they do not need to worry about signing up through the Marketplace or facing any penalties," she said.

The overlap in enrollment periods has generated some confusion, but the state exchanges are for those without insurance or those shopping on the individual market, while those with Medicare don't qualify as they have insurance coverage. The CMS cautions consumers who are making changes to make sure that they are reviewing Medicare plans and not marketplace options.

Salasky can be reached by phone at 757-247-4784.

Need help?

To enroll, call 1-800-MEDICARE, or go to http://www.medicare.gov. For more information about Medicare's prescription drug benefits, visit: http://www.medicare.gov/part-d/. To find out if you qualify for Extra Help paying for prescription drugs, contact Social Security, http://www.socialsecurity.gov, or call 1-800-772-1213. For free, personalized health insurance counseling, call your local Agency on Aging.